Pregnancy outcomes in women diagnosed with Hodgkin lymphoma during pregnancy: a review of the literature

Asmita Kaundal; Yanshen Lambo; Mohim Thakur; Bhavana

doi:10.18203/2320-1770.ijrcog20264043

Authors

Asmita Kaundal Department of OBG, AIIMS, Bilaspur, Himachal Pradesh, India https://orcid.org/0000-0002-6385-9053
Yanshen Lambo Department of Pharmacology, AIIMS, Bilaspur, Himachal Pradesh, India
Mohim Thakur Department of Surgery, AIIMS, Bilaspur, Himachal Pradesh, India
Bhavana Department of OBG, AIIMS, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20264043

Keywords:

Hodgkin disease, Pregnancy, Pregnancy outcome

Abstract

Hodgkin’s lymphoma (HL) is one of the most common haematological malignancies to complicate pregnancy due to its peak incidence in the reproductive age. Constitutional symptoms of the disease may be mistaken for early pregnancy symptoms, delaying diagnosis. Pregnancy neither affects the course nor is it associated with the recurrence of HL. HL has an excellent prognosis with 90% five-year survival if the disease is detected in the early stage and treated adequately. However, treating a pregnant woman with HL is challenging. A multidisciplinary approach is required to diagnose, stage, and start appropriate treatment at the proper gestation to achieve the best pregnancy outcome without compromising the status of the mother. Care should be taken to provide both psychological and emotional support to the couple throughout the pregnancy by a trained healthcare provider. This review offers insight into the presentation, management, and feto-maternal outcomes of pregnant women with HL over the last 15 years.

References

Pavlidis NA. Coexistence of pregnancy and malignancy. Oncologist. 2002;7(6):573.

de Haan J, Lok CAR, Schutte JS, van Zuylen L, de Groot CJM. Cancer related maternal mortality and delay in diagnosis and treatment: a case series on 26 cases. BMC Pregnancy Childbirth. 2018;18:10.

de Haan J, Verheecke M, Van Calsteren K, Van Calster B, Shmakov RG, Mhallem Gziri M, et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol. 2018;19(3):337-346.

Lu D, Ludvigsson JF, Smedby KE, et al. Maternal cancer during pregnancy and risks of stillbirth and infant mortality. J Clin Oncol. 2017;35:1522-1529. doi:10.1200/JCO.2016.69.9439.

Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol. 2003;189(4):1128-1135.

Israel R, Dorer R, Aboulafia DM. Case report of human immunodeficiency virus infection, Hodgkin lymphoma, and pregnancy. Am J Med Sci. 2010;339(2):185-7.

Sagan D, Semczuk A, Lampka E. Combination chemotherapy for Hodgkin's lymphoma during pregnancy: favorable outcome for mother and child. J Obstet Gynaecol Res. 2010;36(4):882-6.

Kassab C, Perini F, Bollmann PW, Kerbauy FR, Hamerschlak N. Hodgkin's disease and pregnancy: case series and proposal for treatment protocol. Einstein (Sao Paulo). 2011;9:216-9.

Iriyama N, Horikoshi A, Tanaka T, Hirabayashi Y, Kodaira H, Hatta Y, et al. Successful treatment of Hodgkin lymphoma in the second trimester of pregnancy: feasibility of ABVD regimen. Int J Hematol. 2011;94:104-107.

Sanchez M, Pellicer B, Cozar MDP, Martínez-Sanjuan V, Villegas C, Carbonell F. Hodgkin lymphoma in pregnancy: a case report. Clin Adv Hematol Oncol. 2013;11(8):533-536. Available from: https://www.hematologyandoncology.net/archives/august-2013/hodgkin-lymphoma-in-pregnancy-a-case-report/ Accessed on o2 September 2026.

Chuang FL, Alcantar JM. Hodgkin lymphoma in a pregnant patient. Proceedings of UCLA Healthcare. 2016;20. Available from: https://escholarship.org/content/qt02t9q220/qt02t9q220_noSplash_bd92780c799742cfb34f1cd96cc84b0f.pdf Accessed on 02 September 2026.

Khattak T, Ali Shah SH, Khan W, Raza SS, Ahmad U, Ullah F. Pregnant lady with undiagnosed Hodgkin's disease presenting as secondary sclerosing cholangitis. J Ayub Med Coll Abbottabad. 2017;29(4):684-5.

Kasonkanji E, Kaimila B, Amuquandoh A, Chikasema M, Tewete B, van der Gronde T, et al. Successful treatment of classical Hodgkin lymphoma during pregnancy in Malawi. J Oncol Pract. 2017;13(5):338-40.

Kroll-Balcerzak R, Baranska M, Gil L, Kazmierczak M, Balcerzak A, Izycki D. Hodgkin lymphoma in pregnancy—current management practice based on case report series. Ginekol Pol. 2019;90(4):233-4.

Cotteret C, Pham YV, Marcais A, Driessen M, Cisternino S, Schlatter J. Maternal ABVD chemotherapy for Hodgkin lymphoma in a dichorionic diamniotic pregnancy: a case report. BMC Pregnancy Childbirth. 2020;20(1):231.

Dunleavy K, McLintock C. How I treat lymphoma in pregnancy. Blood. 2020;136(19):2118-24.

Delzotto J, Naqvi TS, Opara NU, Delzotto A, Morgan A. Unusual presentation of Hodgkin's lymphoma in pregnancy: a case report and systematic review of literature. Hematol Rep. 2022;14(4):322-34.

Li Q, Chang ET, Bassig BA, Dai M, Qin Q, Gao Y, et al. Body size and risk of Hodgkin's lymphoma by age and gender: a population-based case-control study in Connecticut and Massachusetts. Cancer Causes Control. 2013;24(2):287-95.

Huang J, Pang WS, Lok V, Zhang L, Lucero-Prisno DE 3rd, Xu W, et al. Incidence, mortality, risk factors, and trends for Hodgkin lymphoma: a global data analysis. J Hematol Oncol. 2022;15:57.

Wang HW, Balakrishna JP, Pittaluga S, Jaffe ES. Diagnosis of Hodgkin lymphoma in the modern era. Br J Haematol. 2019;184(1):45-59.

Biggar RJ, Jaffe ES, Goedert JJ, Chaturvedi A, Pfeiffer R, Engels EA. Hodgkin lymphoma and immunodeficiency in persons with HIV/AIDS. Blood. 2006;108(12):3786-91.

Murray PG, Young LS. An etiological role for the Epstein-Barr virus in the pathogenesis of classical Hodgkin lymphoma. Blood. 2019;134(7):591-596. doi:10.1182/blood.2019000568.

Kaseb H, Babiker HM. Hodgkin lymphoma. [Updated 2023]. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499969/ Accessed on 02 September 2026.

Abadi U, Koren G, Lishner M. Leukemia and lymphoma in pregnancy. Hematol Oncol Clin North Am. 2011;25:277-91.

Evens AM, Advani R, Press OW, Lossos IS, Vose JM, Hernandez-Ilizaliturri FJ, et al. Lymphoma occurring during pregnancy: antenatal therapy, complications, and maternal survival in a multicenter analysis. J Clin Oncol. 2013;31:4132-9.

Weisz B, Meirow D, Schiff E, Lishner M. Impact and treatment of cancer during pregnancy. Expert Rev Anticancer Ther. 2004;4:889-902.

Andtbacka RH, Donaldson MR, Bowles TL, Bowen GM, Grossmann K, Khong H, et al. Sentinel lymph node biopsy for melanoma in pregnant women. Ann Surg Oncol. 2013;20:689-96.

Eichenauer DA, Aleman BMP, André M, Federico M, Hutchings M, Illidge T, et al. Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4).

McCollough CH, Schueler BA, Atwell TD, Braun NN, Regner DM, Brown DL, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics. 2007;27(4):909-917; discussion 917-918.

American College of Obstetricians and Gynecologists. Guidelines for diagnostic imaging during pregnancy and lactation. Committee Opinion No. 656. Obstet Gynecol. 2016;127.

Office for National Statistics. Cancer survival in England: adults diagnosed. 2019. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/cancersurvivalratescancersurvivalinenglandadultsdiagnosed Accesed on 02 September 2026.

Azim HA Jr, Pavlidis N, Peccatori FA. Treatment of the pregnant mother with cancer: a systematic review on the use of cytotoxic, endocrine, targeted agents and immunotherapy during pregnancy. Part II: Hematological tumors. Cancer Treat Rev. 2010;36(2):110-21.

Pinnix CC, Osborne EM, Chihara D, Lai P, Zhou S, Ramirez MM, et al. Maternal and fetal outcomes after therapy for Hodgkin or non-Hodgkin lymphoma diagnosed during pregnancy. JAMA Oncol. 2016;2:1065-9.

Odelia A, Erel J, Chava P, Yair H, Nadav S, Michael L, et al. Continuing dilemmas in the management of lymphoma during pregnancy: review of a 10-point case-based questionnaire. Int J Clin Oncol. 2017;22:190-9.

Bachanova V, Connors JM. Hodgkin lymphoma in pregnancy. Curr Hematol Malig Rep. 2013;8:211-217.

Moshe Y, Bentur OS, Lishner M, Avivi I. The management of Hodgkin lymphomas in pregnancies. Eur J Haematol. 2017;99:385-91.

Potre O, Pescaru M, Sima A, Ionita I, Tudor R, Borsi E, et al. Evaluation of the relapse risk and survival rate in patients with Hodgkin lymphoma: a monocentric experience. Medicina (Kaunas). 2021;57(10):1026.

Weibull CE, Eloranta S, Smedby KE, Björkholm M, Kristinsson SY, Johansson AL, et al. Pregnancy and the risk of relapse in patients diagnosed with Hodgkin lymphoma. J Clin Oncol. 2016;34:337-44.

Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5:283-91.

Sorosky JI, Sood AK, Buekers TE. The use of chemotherapeutic agents during pregnancy. Obstet Gynecol Clin North Am. 1997;24:591-9.

Khazzaka A, Rassy E, Sleiman Z, Boussios S, Pavlidis N. Systematic review of fetal and placental metastases among pregnant patients with cancer. Cancer Treat Rev. 2022;104:102356.

Greaves M, Hughes W. Cancer cell transmission via the placenta. Evol Med Public Health. 2018;2018(1):106-15.

Greiber IK, Mikkelsen AP, Karlsen MA, Storgaard L, Viuff JH, Mellemkjaer L, et al. Cancer in pregnancy increases the risk of venous thromboembolism: a nationwide cohort study. BJOG. 2021;128(7):1151-9.

Storgaard L, Greiber IK, Pedersen BW, Nielsen BB, Karlsen MA. Cancer in pregnancy—the obstetrical management. Acta Obstet Gynecol Scand. 2024;103(4):630-5.